Positioning for function: wheelchairs and other assistive technologies.
by Adrienne Falk Bergen, P.T, Jessica Presperin, O.TR. & Travis Tallman, CCC-SLP, Valhalla Rehabilitation Publications, Ltd., P.O. Box 195, Valhalla, N.Y. 10595, (914) 948-1004. 387 pages, 1990. $49.95. The following excerpt includes information from Cheryl Colangelo, O.T.R., from the book Positioning the Client With Central Nervous System Defects.
V. ADAPTIVE EQUIPMENT-THE PROS AND CONS
... equipment is a prescriptive item and misuse can be destructive to the rehabilitation process, and the person's physical well-being, and self-image. Most commercially available equipment can be suitably adapted, with appropriate individualized fittings, for each client. Many clients, however, will require individually constructed equipment. Once the equipment has been supplied to a client, continual monitoring will be necessary to check the fit and suitability. Modifications are indicated when there are changes in functioning, growth, and so on.
When recommending static adapted equipment one should consider the impact on individuals and their caregivers in motor, cognitive/perceptual, and psychosocial areas. Since the prescription and design of equipment to meet motoric needs is in itself a challenge, it may be easy to lose sight of equally essential aspects of the client's life. The impact of a piece of equipment on cognitive/perceptual and psychosocial development must be taken into account. The final decision as to what pieces of equipment will be provided and when and where it will be used, should be made by weighing the pros and cons for not only motor but also cognitive and psychosocial needs. This is where the team process can lend perspective...
Good specialized equipment can serve all the purposes already mentioned - normalize tone, decrease the influence of pathological reflexes, increase ROM (range of motion passive and active), decrease the tendency towards deformities, increase stability, and facilitate components of normal movement in a developmental sequence. All of these will help provide the sensation of good body alignment while contributing to increased function.
On the other hand, static positioning devices do not respond to the client's self-initiated movements. Equipment cannot withdraw as the client begins to show a postural response. Thus, the equipment, when used without proper judgement and continuous supervision, can block function if the client's status changes.
Adaptive equipment provides clients with postural support so they can direct their energies toward participation in their environment. Without central control, a person may expend a great deal of effort in an attempt to fight gravity, maintain equilibrium, and deal with the fear of falling. When these problems are reduced, clients may better attend to visual and auditory stimulation. They have a more stable base from which to exercise fine motor control, so their ability to manipulate and use objects may improve.
... equipment on wheels may provide mobility to clients who have no other means of self-propulsion, or to those whose movements are so slow that the effort is not worth the goal toward which it is directed. Thus, a world of exploration is opened...
There are drawbacks. The provision of equipment necessarily limits some kinds of sensory feedback. Because of the nature of positioning, meaningful tactile and kinesthetic stimulation is often limited to the face and arms, as the rest of the body is generally maintained in a static position, with constant pressure and relative joint immobility..
Good positioning with concurrent increase in function, can reduce dependence and improve self-esteem and personal gratification...
... it may make individuals more accepted by "society" Whether we like it or not this is a visually-oriented society..
... a person provided with equipment that enhances function may be a more active participant in group activities...
Lastly, one should consider how the bulk of the equipment affects the person. Too often, equipment limits physical contact. A spontaneous hug is almost impossible with a child strapped in a wheelchair with a head support, upper extremity support surface, and protraction blocks. No one can tickle or roughhouse with such a child, and the opportunities for simple, unplanned gestures of affection are limited...
Equipment cannot provide one hundred percent of any single need; a balance can be made, based on the priorities of the individual involved. Priorities need to be discussed extensively. In all instances, families and clients must be realistically informed. They must be encouraged to discuss their expectation of the equipment. Everyone involved must understand that equipment may not be "perfect"...
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|Title Annotation:||excerpt, includes excerpt from Positioning the Client With Central Nervous System Defects|
|Author:||Bergen, Adrienne Falk; Presperin, Jessica; Tallman, Travis; Colangelo, Cheryl|
|Publication:||The Exceptional Parent|
|Date:||Mar 1, 1991|
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